Development and validation of a transanal endoscopic rectal purse string simulator.

Area of Science:

• Surgical Simulation
• Medical Education Technology
• Minimally Invasive Surgery

Background:

• Rectal purse string placement for transanal mesorectal excision is technically demanding.
• Limited practice opportunities exist for this crucial surgical skill.
• A need for a validated training tool for endoscopic rectal purse string placement was identified.

Purpose of the Study:

• To develop and validate a low-cost endoscopic rectal purse string simulator.
• To assess the simulator's utility in evaluating surgical trainees' skills.

Main Methods:

• A novel, cost-effective transanal endoscopic rectal purse string simulator was engineered.
• General surgery residents, fellows, and staff surgeons participated.
• Performance was evaluated using task completion time, Objective Structured Assessment of Technical Skills (OSATS), and Advanced Laparoscopic Suturing (ALS) scores.

Main Results:

• Thirty-nine participants were stratified into three groups based on laparoscopic suturing experience.
• Significant differences in time to completion, OSATS, and ALS scores were observed across groups (p < 0.05).
• Surgeons with prior laparoscopic experience demonstrated significantly faster completion times and higher skill scores compared to residents.

Conclusions:

• A functional endoscopic rectal purse string simulator was successfully constructed.
• Simulator performance correlates with prior laparoscopic suturing experience.
• The simulator shows promise as a valid tool for assessing and training rectal purse string placement skills.